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Macular atrophy after aflibercept therapy for neovascular age-related macular degeneration: outcomes of Japanese multicenter study

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Abstract

Purpose

To evaluate the development and rate of growth in macular atrophy after intravitreal injections of aflibercept (IVAs) for neovascular age-related macular degeneration (AMD) over a 2-year period.

Study design

Retrospective, interventional, consecutive case series.

Methods

This study included 94 eyes of 92 patients with treatment-naïve AMD involving the foveal center treated with IVAs at 3 university hospitals in Japan. The patients underwent IVAs bimonthly after 3 initial monthly doses in the first year. The protocol was converted to a treat-and-extend regimen in the second year. The incidence and growth rate of macular atrophy were quantified based on hypoautofluorescence detected by fundus autofluorescence images. Additionally, possible background factors related to the development and rate of growth of macular atrophy were investigated.

Results

Of 94 eyes, 39 (41.5%) had typical AMD and 55 (58.5%) had polypoidal choroidal vasculopathy. Ten eyes (10.6%) had macular atrophy at the baseline. Of the remaining 84 eyes, 14 (16.7%) had developed new macular atrophy at 2 years, the square root of the growth rate of atrophy was 0.52 mm/year. In multivariate analyses, a poorer best-corrected visual acuity (P = 0.01) and the presence of intraretinal fluid (P = 0.04) at baseline were found to be the independent predictors for the development of macular atrophy. No factors were found that were significantly related to the growth rate of the macular atrophy.

Conclusions

Our study determined the incidence and rate of growth of macular atrophy after IVAs for neovascular AMD in clinical settings. Eyes with vision reduction and intraretinal fluid at the baseline develop macular atrophy more frequently after IVAs for neovascular AMD.

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Acknowledgements

The authors thank Ryo Kawasaki, Department of Ophthalmology, Osaka University, and Yuji Yamamoto, Department of Ophthalmology, Kyoto Prefectural University of Medicine, for statistical expertise. This study was supported in part by Grant No. 25670739 from the Ministry of Education, Culture, Sports, Science and Technology-Japan (H.K.).

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Authors and Affiliations

  1. Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo, Japan

    Hideki Koizumi, Ichiro Maruko, Taiji Hasegawa & Tomohiro Iida

  2. Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0125, Japan

    Hideki Koizumi

  3. Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan

    Akiko Yamamoto & Annabelle A. Okada

  4. Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan

    Masashi Ogasawara, Kanako Itagaki & Tetsuju Sekiryu

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  1. Hideki Koizumi
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Correspondence to Hideki Koizumi.

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Conflicts of interest

H. Koizumi, Lecture fee (Novartis, Topcon, Otsuka, Pfizer, HOYA, Bausch + Lomb, Bayer, Alcon, Santen, Senju, Kowa, JFC); A. Yamamoto, Speaker fee (Novartis, Bayer, Santen); M. Ogasawara, Lecture fee (Novartis, Bayer, Santen); I. Maruko, Speaker fee (Novartis, Bayer, Santen, Alcon, Topcon, Senju, NIDEK, Canon); T. Hasegawa, Speaker fee (Novartis, Bayer, Santen, Kowa, Alcon, Senju, NIDEK, Canon, Acura, RE Medical, Nikon); K. Itagaki, Lecture fee (Novartis, Bayer, Santen); T. Sekiryu, Lecture fee (Novartis, Bayer, NIDEK, Kowa, Topcon, Santen, Senju, Alcon, HOYA, JFC); A. A.Okada, Lecture fee and Consultant fee (Novartis, Bayer, HOYA, Daiichi Sankyo, Astellas), Lecture fee (Pfizer, Santen, Mitsubishi Tanabe, Alcon, Senju, AbbVie); T. Iida, Lecture fee and Consultant fee (Chugai, Bayer), Lecture fee (Novartis, NIDEK, Kowa, Canon, Topcon, Santen, Senju, Alcon, HOYA, AMO, Pfizer, Otsuka, JFC, Nikon).

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Corresponding Author: Hideki Koizumi

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Koizumi, H., Yamamoto, A., Ogasawara, M. et al. Macular atrophy after aflibercept therapy for neovascular age-related macular degeneration: outcomes of Japanese multicenter study. Jpn J Ophthalmol 64, 338–345 (2020). https://doi.org/10.1007/s10384-020-00745-0

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  • DOI: https://doi.org/10.1007/s10384-020-00745-0

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